Provider Demographics
NPI:1528256690
Name:SOMERS, EDWARD LEE (LMHC, CEAP, NCC,NBCC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LEE
Last Name:SOMERS
Suffix:
Gender:M
Credentials:LMHC, CEAP, NCC,NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N WOODLAND BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4245
Mailing Address - Country:US
Mailing Address - Phone:321-277-7714
Mailing Address - Fax:386-734-2475
Practice Address - Street 1:101 N WOODLAND BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4245
Practice Address - Country:US
Practice Address - Phone:321-277-7714
Practice Address - Fax:386-734-2475
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-14
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0001884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health